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Anesthesia

Neck pain after C-section

06/07/2006

Question:

It has been almost 3 weeks since my section and i am still experiencing pain in my neck which eventually leads to a bad headache. The neck pain is very tender to the touch and very annoying. It seems to get worse if I lie down, especially on my back. It almost feels like a sinus headache at the base of my head. During my operation I had shoulder pain. Then later in the day it moved to the side of my neck and now at the base of my head. My doctor thinks it is referred pain from the operation. I just want to know that this will go away, he said it could last 2 weeks but it has been 3. I have been taking advil but stopped about 4 days ago because the pain is still there. What do you think?

Answer:

I'm not sure what is causing your pain but I can comment on whether it might be related to your anesthetic.

About 1 in every 100 or 200 patients who have an epidural or spinal anesthetic - (I am assuming this is what you had) - end up with a headache. This headache has particular characteristics. It's often a really bad headache, but usually goes away after a week or so, although it can persist for longer. The most important, distinguishing feature of this particular headache is that the headache will go away when you lie down. Because your headache gets worse when you lie down, I really don't think this is what you have.

Shoulder pain during cesarean section is quite common. It is, as you said, "referred" pain. Another example of referred pain is the discomfort felt in the arm or neck that some people get with heart pain (angina).This means that there isn't anything wrong with your shoulder. Rather, the pain is felt there as a result of physical trauma elsewhere. In the case of a cesarean section, the shoulder pain is probably due to irritation of the peritoneum. The strange phenomenon of referred pain is due to the way the nervous system is "wired". The referred shoulder pain from a cesarean section normally doesn't last more than a few days, and doesn't migrate to the neck or base of the head the way you've described.

After 3 weeks, the pain from a cesarean section should be very manageable, although not entirely gone. It would be quite unusual to experience the pain you've described. Perhaps something else is going on - sinus headache, fibromyalgia, or some other muscular or skeletal problem. However it sounds as though the Advil wasn't helping you, which makes a muscular/skeletal problem a bit less likely.

My recommendation, if the pain is not improving, is to go see your doctor again or seek a second opinion.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University